ARTERIOVENOUS MALFORMATIONS IN FUNCTIONAL AREAS OF THE BRAIN.

Abstract

For Arteriovenous Malformations (AVMs) in so-called \`non-eloquent' brain regions, the therapeutic regimen is rather straightforward unless they are giant (>6 cm): in experienced hands microsurgical removal has the highest success rates with regard to complete AVM elimination as well as to associated morbidity when compared with the other treatment modalities. In patients with giant AVMs or with AVMs in \`eloquent' (i.e. functional) regions, however, morbidity—transient and permanent—may be high. They may be subject to various therapeutic options from microsurgery or radiosurgery alone to combined approaches (e.g. embolization + radiosurgery or embolization + microsurgery + radiosurgery) depending on size and location. It needs to be pointed out that even in these difficult lesions the ultimate goal of any therapeutic approach in AVM patients remains complete DSA-controlled obliteration of the AVM in order to avoid subsequent rupture with the potential for life-threatening bleeding. Few books deal with cerebral AVMs in detail, and Professor Shokei Yamada has undertaken the task to report on his surgical experience with 135 AVMs located in `functional' brain regions. The book is structured in 12 chapters, with five written by Professor Yamada himself and the remaining seven by renowned experts in their respective fields. On initial browsing some technical shortcomings of the book become evident. First, most chapters of the book are subdivided into subsections, which are not mentioned in the index of contents. Secondly, many intraoperative photographs and angiographic pictures are dark and not in focus. Thirdly, the figures drawn by the medical illustrator tend to be too simplistic, in particular, when it comes to descriptions of surgical technique, where elaborate drawings could be of great value to foster understanding. Fourthly, some figure legends are incomplete: What is the meaning of the three arrows in Figure 10C, etc.? Last but not least, in the preface, the names …